| NPI | 1649284043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME109489) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 35062996) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2013-05-08 |